Elaboration of a global policy for older people 'Senior+'

Why was this example implemented?

In its political strategy for old age (2007), the Swiss Federal Council stresses five major themes: health and care, housing and mobility, work and transition toward retirement, economic situation of retired people, social engagement and participation. The Constitution of the Fribourg canton asserts in particular that older people have the right to participation, autonomy, quality of life and respect (art. 35 of the Constitution). In 2006, two members of the canton parliament put in a request for a global policy for older people (Postulat Weber-Gobet and Thomet, September 8th, 2006) that would be developed with the participation of ‘concerned groups’, i.e. older people and professionals. This is where the research project ‘Senior+’ originated from.

Within this context, the goal of the project is to develop a concept and a legal framework for old age policy by taking into account the complexity of  variables that have an impact on  social and health factors and on the ageing process. In order to achieve this goal, the policy aims to limit the gaps between the several stakeholders by clarifying the responsiblities and thus achieving a more equitable distribution of the financial burden of long-term care between the health and social care sectors.

The project focuses on three main aspects of the life of older people: health (in particular the period of frailty and of higher risk of dependency, as well as end of life care), social integration and  financial situation. The basic idea is that older people have resources from which society could benefit and are not just a cause of the problems.

The new policy should be finalised with a new law in 2013 or 2014.

Description

The aim of the project is to create a new old-age policy that will eliminate gaps between the social and health care sectors.

The creation of a new policy for old age of the Fribourg canton is led by two non-political, external researchers (a political scientist and an anthropologist). They are in charge of the preparatory work for this global policy  for older people and are employed by the Department for Health and Social Affairs. Their salary is the only cost of the project. All other stakeholders participate in the project as volunteers.

Their methodology includes involving partners through focus-group meetings of representatives from health,  social and economic fields. These focus-group meetings  aim to bring together those people who will have to put the elements of the new old age policy into practice.  Partners come from various organisations that have a link to old age in the canton, among them medical and social services active in long-term care (eg. Home Care Organisations, care homes, Association for Transport and Environment, Service for Social Action, Cantonal Service for Public Health). Older people are represented by members from the Cantonal Federation of Retired People, and by the Alzheimer Association. An important professional organisation for the social and political defense of older people (Pro Senectute Fribourg) is also represented. Together, they are defining chapter headings of the policy in order for the document to be tuned into the needs of the target groups (i.e. informal carers and older people). They are required to formulate objectives and concrete ways of developing the policy in practice.

Experts - about 20 specialists from the scientific field - are asked to evaluate the project and its feasibility. These stakeholders are all volunteers and get no payment for their participation.

There is also a steering committee which is largely made up of political representatives coming from diverse governmental levels (canton, districts and municipalities). Its role is to accept or refuse the proposals of the research group that will then be brought to the Canton Executive. To be implemented as a law, this project has to be accepted by partners through consultation and voted in Parliament.

What are/were the effects?

The project ‘Senior+’ is still ongoing, therefore no external evaluation has been carried out as yet; however, some main elements can be underlined.

Firstly, the potential effect of ‘Senior+’ is to reduce gaps between the health and social care aspects of long-term care, in order to ensure a better global quality of life for older people and limit the need for long-term care. Bringing together stakeholders to define the concrete aspects that a policy for older people must cover is potentially a good way to improve interagency working and generate a better understanding of other needs and resources. This can help to bridge the gaps and ensure an improved coordination between stakeholders in long-term care, thus achieving one of the goals of the project.

Secondly, the canton is the only one that has fundamentally taken into account the recommendations of the Federal Government by developing a global and cantonal old age policy (see Lucas, 2010). In this sense, it is astutely carrying out the duties of the cantonal authorities. At the same time, other national or cantonal projects are taken into consideration such as several revisions of federal and cantonal laws that can have an impact on old age policy. This is an example of a canton attempting to position itself as part of a more global political entity rather than act alone.

Thirdly, representatives from the social and health care  fields are brought together to promote a view of older people who may be  in need of long-term care, not only as   users but also as  stakeholders of civil society, with social rights and needs, duties and responsibilities. This fits  in with the statement that  better social integration of older people contributes to better health, thus potentially lowering the need for care.

Although it is difficult to evaluate the number of people who will be affected directly or indirectly by the new policy, according to the cantonal statistics of 2009, more than 82,000 people aged 50 and over (out of 273,000 total population) live in the canton and are the focus of the project.

What are the strengths and limitations?

Strengths

The project is a constructive approach that brings together various stakeholders from the social, economic and health care fields. It has the potential to impact on quality of life and reduce the need for long-term care.

Weaknesses

The interests of formal and informal carers may take a back seat because of financial limitations imposed by policy-makers. Informal carers are not formally represented in the groups that take part in the elaboration of the project. This prevents the project from directly taking into consideration the needs and resources of the most important  caregivers.

Opportunities and Threats

The fact that informal carers are not organised as a group in the region prevents the  legitimate representation of this sector. This is a practical problem over which those responsible for the project do not have any influence. However they could provide the opportunity for informal carers to be recognised and representated in future policy making and planning of services.

Other opportunities and limitations may become visible by the end of the project, when the policy is put into practice.

Credits

Author: Marion Repetti
Reviewer 1: Hannelore Jani
Reviewer 2: Jorge Garces
Verified by: Direction de la santé et des affaires sociales, Fribourg (CH). http://www.fr.ch/sps/fr/pub/projets/senior_plus/contexte.htm

Links to other INTERLINKS practice examples

• Bridging the gap between nursing home and community care (the Skævinge Project)
• Charter of Rights for People in Need of Long Term Care and Assistance
• The ‘Big Care Debate’ – public engagement in LTC funding

External Links and References

• Description of the project by the cantonal responsible governmental service
• Lucas, B. (2010). 'Politiques du care et gouvernement de la vie. Une typologie des pratiques locales en Suisse' in: Swiss Political Science Review, Vol 16(1):109–46.
• Presentation of the project